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Lessons Learned from the Multi-Country HIV/AIDS Program in Africa: Key Insights for the Public Sector

This document provides a comprehensive overview of the experiences and lessons learned from the Multi-Country HIV/AIDS Program (MAP) in Africa, focusing on the public sector's response to the HIV/AIDS crisis. Highlighting the necessity of a multi-sector approach, it emphasizes involving all line ministries and stakeholders to strengthen the fight against HIV/AIDS. The report discusses the challenges faced, key questions for effective implementation, and mixed experiences in various countries. It concludes with strategic recommendations for enhancing political commitment, resource allocation, and collaborative efforts to scale up responses effectively.

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Lessons Learned from the Multi-Country HIV/AIDS Program in Africa: Key Insights for the Public Sector

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  1. Multi-Country HIV/AIDS Program (MAP)Public Sector Response:Lessons Learned Africa Region HIV/AIDS Consultation Addis Ababa February 14-18, 2004 John F. May, World Bank

  2. SOURCES • In-country experiences • Turning Bureaucrats into Warriors, 2004 • MAP Interim Review, 2004

  3. BACKGROUND • HIV/AIDS is recognized as a development issue • Multi-sector approach necessary • Involvement of all groups in society • Fostering a stronger demand to use available services

  4. RATIONALE • HIV/AIDS is much broader than a public health problem • HIV/AIDS touches virtually ALL sectors of the economy • Some sectors may be contributing to the epidemic, but at the same time are a MAJOR asset in the fight against it (e.g., education in Cameroon)

  5. THE CHALLENGES (1) • Identify and involve the constituencies: • Line Ministries employees & families • The groups they interact with (their own external clients and stakeholders)

  6. THE CHALLENGES (2) • Identify full-time Focal Points/Teams • Create strong commitment • Mitigate high turn-over • Increase absorptive capacity • Obtain counterpart funding • Change work place policies • Include PLWHA and their families

  7. KEY QUESTIONS (1) • Involve all Line Ministries or only key Line Ministries? • Vertical or integrated approach? • Roles of NAS and NAC? • How to build capacity in Line Ministries?

  8. KEY QUESTIONS (2) • How to coordinate all Line Ministries programs on the ground? • How to M&E these programs? • How to link them with other HIV/AIDS activities, e.g. communities activities?

  9. MIXED EXPERIENCES (1) • Line Ministries are usually signed up • Slow implementation of Actions Plans • Lack of strong ownership • Weak commitment • Limited capacity • Low absorptive capacity

  10. MIXED EXPERIENCES (2) • Line Ministries operate on their own • They operate at the central level; less activities at the decentralized levels • Lots of IEC, but much less BCC • Are beneficiaries actually seeking services? • Lack of strong linkages with Communities and Civil Society Initiatives (CCSI)

  11. MIXED EXPERIENCES (3) • Successes may be linked to one outstanding individual (Focal Point, NAS Line Ministries coordinator, one dedicated Line Ministry) (e.g., Sierra Leone, Cape Verde) • Financial architecture problems • No real out-sourcing culture in public sector

  12. MIXED EXPERIENCES (4) • Revitalization of public sector response is difficult • Some restructuring at Mid-Term Reviews • Promising attempts to jump start public sector response with Accelerated Results Implementation (ARI) approach (e.g., Sierra Leone, The Gambia)

  13. LESSONS LEARNED (1) • Line Ministries are essential partners for mainstreaming HIV/AIDS, but are not yet fully involved • HIV/AIDS is seen as Ministry of Health’s mandate • Lack of resources • Low capacity

  14. LESSONS LEARNED (2) • Scaling up in line ministries is taking longer than expected, in part because of institutional weaknesses within sector ministries • Too few and powerless Focal Points • Move beyond Focal Points to Units (AIDS Control Units, e.g. Kenya)

  15. LESSONS LEARNED (3) • Political will is necessary to mobilize sector ministries • Need for support from highest levels of leadership • Need for budget lines in annual budgets

  16. LESSONS LEARNED (4) • The Ministry of Education is pivotal in the fight against HIV/AIDS, but often among the most difficult to mobilize • Largest employer in many countries • Difficulty to create consensus

  17. LESSONS LEARNED (5) • Getting started • Situation analysis (among staff and clients) • Sensitize Line Ministry leadership • Liaise with NAS • Build bridges between countries

  18. LESSONS LEARNED (6) • The partnership with the NAS has to be stronger • Mutually beneficial, not adversarial relationship • NAS needs to provide proactive capacity building

  19. LESSONS LEARNED (7) • Contracting additional support is an option • Private sector • NGO • Other public agencies

  20. LESSONS LEARNED (8) • Lack of funds for scaling up sector responses Some Line Ministries may need more resources than others

  21. LESSONS LEARNED (9) • Although all ministries should be given equal opportunity to start HIV/AIDS activities, let a few ministries take the lead in the first year

  22. THE WAY FORWARD (1) • The Three Ones: • One National HIV/AIDS Strategy • One Coordinationg Authority • One M&E System

  23. THE WAY FORWARD (2) • Stronger Political Commitment • Stronger ownership • Line Ministries specific HIV/AIDS budgets • Contracting out additional support • Linkages with other partners

  24. THE WAY FORWARD (3) • Five priority areas • Prevention and advocacy • Care and support • Socio-economic impact mitigation • Monitoring and evaluation • Management and coordination

  25. CONCLUSIONS • The Public Sector Response remains fundamental in the fight against HIV/AIDS • Need to go beyond a template approach • Need to tap Line Ministries’ comparative advantages • Emergence of a second-generation implementation mode

  26. Ameseghinalehu ! (Thank you !)

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